Disease-specific cognitive impacts in aging: a large-scale longitudinal analysis of chronic conditions and demographic modifiers.
4 affiliations
- 1Department of Anesthesiology and Perioperative Medicine, General Hospital of Ningxia Medical University, 804 Shengli Street, Xingqing Area, Yinchuan, Ningxia, China.
- 2Department of Anesthesiology, Clinical Medical College and The First Affiliated Hospital of Chengdu Medical College, Chengdu, Sichuan, China.
- 3Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, China.
- 4Department of Anesthesiology and Perioperative Medicine, General Hospital of Ningxia Medical University, 804 Shengli Street, Xingqing Area, Yinchuan, Ningxia, China. [email protected].
Abstract
Background
Cognitive decline represents a major public health concern among aging populations, yet the domain-specific impacts of chronic diseases remain poorly understood. This study examined associations between chronic diseases and specific cognitive domains, exploring heterogeneity across population subgroups.Methods
We analyzed longitudinal data from the China Health and Retirement Longitudinal Study across three waves (2015, 2018, 2020; ~2-3-year intervals), comprising 16,027 participants aged 45-90 years (35,247 observations). Continuous cognitive outcomes (orientation, memory, computation, and total score) were standardized (z-scores), so β represents the SD-unit difference in cognitive score for disease presence versus absence; drawing ability, a binary outcome, was analyzed via logistic regression and reported as an odds ratio. These outcomes were modeled against 14 chronic conditions using mixed-effects models adjusted for demographic, lifestyle, and health covariates and for co-occurring conditions. P-values were corrected for multiple comparisons (56 tests), and effect modification by education and sex was tested formally.Results
Nine of fourteen conditions remained significant after correction. Memory-related disease showed the broadest impairment, affecting total cognition (β=-0.292, P < 0.001), orientation (β=-0.326), and memory (β=-0.190). Chronic lung disease (β=-0.062) and emotional/psychiatric disorders (β=-0.158) were also negatively associated with cognition, as was stroke (β=-0.127). Heart disease (β=+0.109) and liver disease (β=+0.087) showed unexpected positive associations, which we interpret cautiously given the absence of clinical severity data. Education significantly modified the associations for stroke, chronic lung disease, and emotional/psychiatric disorders (all P < 0.05), with greater vulnerability among more-educated participants; no disease-by-sex interaction was significant.Conclusion
Chronic diseases show distinct, domain-specific cognitive impacts, with education-but not sex-modifying a subset of these associations. These findings support disease-specific rather than uniform approaches to cognitive risk assessment in aging populations.
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BibTeX
@article{wang2026diseasespecific,
title = {{Disease-specific cognitive impacts in aging: a large-scale longitudinal analysis of chronic conditions and demographic modifiers.}},
author = {Shun Wang and Fengxiang Song and Bingbing Xiang and Liqin Deng},
journal = {BMC public health},
year = {2026},
month = jul,
doi = {10.1186/s12889-026-28734-x},
url = {https://europepmc.org/article/MED/43009876},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Disease-specific cognitive impacts in aging: a large-scale longitudinal analysis of chronic conditions and demographic modifiers.
AU - Shun Wang
AU - Fengxiang Song
AU - Bingbing Xiang
AU - Liqin Deng
PY - 2026
DA - 2026/07/28
JO - BMC public health
DO - 10.1186/s12889-026-28734-x
UR - https://europepmc.org/article/MED/43009876
AB - Background Cognitive decline represents a major public health concern among aging populations, yet the domain-specific impacts of chronic diseases remain poorly understood. This study examined associations between chronic diseases and specific cognitive domains, exploring heterogeneity across population subgroups.Methods We analyzed longitudinal data from the China Health and Retirement Longitudinal Study across three waves (2015, 2018, 2020; ~2-3-year intervals), comprising 16,027 participants aged 45-90 years (35,247 observations). Continuous cognitive outcomes (orientation, memory, computation, and total score) were standardized (z-scores), so β represents the SD-unit difference in cognitive score for disease presence versus absence; drawing ability, a binary outcome, was analyzed via logistic regression and reported as an odds ratio. These outcomes were modeled against 14 chronic conditions using mixed-effects models adjusted for demographic, lifestyle, and health covariates and for co-occurring conditions. P-values were corrected for multiple comparisons (56 tests), and effect modification by education and sex was tested formally.Results Nine of fourteen conditions remained significant after correction. Memory-related disease showed the broadest impairment, affecting total cognition (β=-0.292, P < 0.001), orientation (β=-0.326), and memory (β=-0.190). Chronic lung disease (β=-0.062) and emotional/psychiatric disorders (β=-0.158) were also negatively associated with cognition, as was stroke (β=-0.127). Heart disease (β=+0.109) and liver disease (β=+0.087) showed unexpected positive associations, which we interpret cautiously given the absence of clinical severity data. Education significantly modified the associations for stroke, chronic lung disease, and emotional/psychiatric disorders (all P < 0.05), with greater vulnerability among more-educated participants; no disease-by-sex interaction was significant.Conclusion Chronic diseases show distinct, domain-specific cognitive impacts, with education-but not sex-modifying a subset of these associations. These findings support disease-specific rather than uniform approaches to cognitive risk assessment in aging populations.
SN - 1471-2458
ER -